BACKGROUND: Maintaining a steady thrombolysis service for treatment of acute ischemic stroke 24 h/7 days is challenging. Diurnal and seasonal variability of stroke onset affects the clinical outcome of these patients. HYPOTHESIS: We state that a 24 h/7 days availability of stroke-trained physicians ameliorates weekend effects and other seasonal, weekday, or non-office-hour-related influences on outcome of ischemic stroke patients treated with intravenous thrombolysis. METHODS: All consecutive ischemic stroke patients treated with thrombolysis at the Helsinki University Central Hospital were prospectively registered (n = 1581). Patients with basilar artery occlusion (n = 154) were excluded. Door-to-needle time, three-month clinical outcome as measured by the modified Rankin Scale dichotomized at 0 to 2 vs. 3 to 6, and symptomatic intracerebral hemorrhage were analyzed with logistic regression models adjusting for baseline variables. The treating physician was defined as experienced after 18 decisions made to give thrombolysis treatment. RESULTS: Door-to-needle time or clinical outcome did not differ with regard to time of day or season of presentation. Higher rates of symptomatic intracerebral hemorrhage occurred in spring (odds ratio 2·06, 95% confidence interval 1·03-4·11) and fall (odds ratio 2·08, 95% confidence interval 1·03-4·18). Physician experience reduced the door-to-needle time (odds ratio 0·40, 95% confidence interval 0·32-0·50) but was not associated with patient outcome (modified Rankin scale 3 to 6, odds ratio 1·22, 95% confidence interval 0·95-1·59) or symptomatic intracerebral hemorrhage (odds ratio 0·80, 95% confidence interval 0·51-1·27) rates. CONCLUSIONS: Thrombolytic therapy can be delivered at a steady service level at all times. With proper training, less-experienced physicians can provide high quality thrombolysis, but experience translates into faster treatment.
BACKGROUND: Maintaining a steady thrombolysis service for treatment of acute ischemic stroke 24 h/7 days is challenging. Diurnal and seasonal variability of stroke onset affects the clinical outcome of these patients. HYPOTHESIS: We state that a 24 h/7 days availability of stroke-trained physicians ameliorates weekend effects and other seasonal, weekday, or non-office-hour-related influences on outcome of ischemic strokepatients treated with intravenous thrombolysis. METHODS: All consecutive ischemic strokepatients treated with thrombolysis at the Helsinki University Central Hospital were prospectively registered (n = 1581). Patients with basilar artery occlusion (n = 154) were excluded. Door-to-needle time, three-month clinical outcome as measured by the modified Rankin Scale dichotomized at 0 to 2 vs. 3 to 6, and symptomatic intracerebral hemorrhage were analyzed with logistic regression models adjusting for baseline variables. The treating physician was defined as experienced after 18 decisions made to give thrombolysis treatment. RESULTS: Door-to-needle time or clinical outcome did not differ with regard to time of day or season of presentation. Higher rates of symptomatic intracerebral hemorrhage occurred in spring (odds ratio 2·06, 95% confidence interval 1·03-4·11) and fall (odds ratio 2·08, 95% confidence interval 1·03-4·18). Physician experience reduced the door-to-needle time (odds ratio 0·40, 95% confidence interval 0·32-0·50) but was not associated with patient outcome (modified Rankin scale 3 to 6, odds ratio 1·22, 95% confidence interval 0·95-1·59) or symptomatic intracerebral hemorrhage (odds ratio 0·80, 95% confidence interval 0·51-1·27) rates. CONCLUSIONS: Thrombolytic therapy can be delivered at a steady service level at all times. With proper training, less-experienced physicians can provide high quality thrombolysis, but experience translates into faster treatment.
Authors: Morteza Noshad; Christian C Rose; Robert Thombley; Jonathan Chiang; Conor K Corbin; Minh Nguyen; Vincent X Liu; Julia Adler-Milstein; Jonathan H Chen Journal: AMIA Annu Symp Proc Date: 2021-01-25
Authors: Valerian L Altersberger; Patrick R Wright; Sabine A Schaedelin; Gian Marco De Marchis; Henrik Gensicke; Stefan T Engelter; Marios Psychogios; Timo Kahles; Martina Goeldlin; Thomas R Meinel; Pasquale Mordasini; Johannes Kaesmacher; Alexander von Hessling; Jochen Vehoff; Johannes Weber; Susanne Wegener; Stephan Salmen; Rolf Sturzenegger; Friedrich Medlin; Christian Berger; Ludwig Schelosky; Susanne Renaud; Julien Niederhauser; Christophe Bonvin; Michael Schaerer; Marie-Luise Mono; Biljana Rodic; Guido Schwegler; Nils Peters; Manuel Bolognese; Andreas R Luft; Carlo W Cereda; Georg Kägi; Patrick Michel; Emmanuel Carrera; Marcel Arnold; Urs Fischer; Krassen Nedeltchev; Leo H Bonati Journal: Eur Stroke J Date: 2022-04-27
Authors: Anne Margreet van Dishoeck; Diederik W J Dippel; Maaike Dirks; Caspar W N Looman; Johan P Mackenbach; Ewout W Steyerberg Journal: Cerebrovasc Dis Extra Date: 2014-06-24